Zhong Nanzhe, Leng Ao, He Shaohui, Yang Minglei, Zhang Dan, Jiao Jian, Xu Wei, Yang Xinghai, Xiao Jianru
Department of Orthopedic Oncology and Spinal Tumor Center, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, People's Republic of China.
Cancer Manag Res. 2019 Jul 24;11:6971-6979. doi: 10.2147/CMAR.S201372. eCollection 2019.
To investigate the outcome and prognostic factors of surgery in treating gastric cancer spinal metastasis (GCSM).
A total of 17 patients with GCSM who have undertaken spinal surgeries have been identified. Kaplan-Meier method and univariate analysis are adopted to investigate the prognostic factors affecting overall survival (OS) and progression-free survival (PFS).
The median PFS and OS are 11.3 months (95% CI: 7.8-14.9 months) and 11.9 months (95% CI: 8.4-15.4 months), respectively. Postoperatively, all patients had substantial pain relief, with mean visual analog scale score descending from 6.6±1.6 to 3.4±1.2. Meanwhile, patients also showed improved neurological functions, with 8 of them having improvements of at least one level in Frankel classification. Univariate analysis presented that patients with carcinoembryonic antigen (CEA)<6 µg/L (=0.020), lactate dehydrogenase (LDH)<300 U/L (=0.012), alkaline phosphatase (ALP)<200 U/L (=0.007), and Tokuhashi score>6 (=0.027) show longer OS. Moreover, application of bone cement, low level of ALP (<200 U/L), and LDH (<300 U/L) are associated with longer PFS (<0.05).
Surgery is an efficient option in treating GCSM, due to its efficacy in pain alleviation, function restoration, and stability reconstruction. Low levels of CEA, LDH, ALP, and high Tokuhashi score (>6) are all favorable factors for better OS, whereas low levels of LDH, ALP, and application of bone cement are related with longer PFS.
探讨手术治疗胃癌脊柱转移（GCSM）的疗效及预后因素。
共纳入17例行脊柱手术的GCSM患者。采用Kaplan-Meier法和单因素分析来研究影响总生存期（OS）和无进展生存期（PFS）的预后因素。
中位PFS和OS分别为11.3个月（95%CI：7.8 - 14.9个月）和11.9个月（95%CI：8.4 - 15.4个月）。术后，所有患者疼痛均大幅缓解，视觉模拟量表平均评分从6.6±1.6降至3.4±1.2。同时，患者神经功能也有所改善，其中8例Frankel分级至少提高了一个级别。单因素分析显示，癌胚抗原（CEA）<6 μg/L（=0.020）、乳酸脱氢酶（LDH）<300 U/L（=0.012）、碱性磷酸酶（ALP）<200 U/L（=0.007）以及Tokuhashi评分>6（=0.027）的患者OS更长。此外，骨水泥的应用、低水平的ALP（<200 U/L）和LDH（<300 U/L）与更长的PFS相关（<0.05）。
手术是治疗GCSM的有效选择，因其在缓解疼痛、恢复功能和重建稳定性方面具有疗效。低水平的CEA、LDH、ALP以及高Tokuhashi评分（>6）均是OS较好的有利因素，而低水平的LDH、ALP以及骨水泥的应用与更长的PFS相关。
